糖代谢异常对原发性高血压患者颈动脉粥样硬化的作用

Effects of impaired glucose metabolism on the carotid atheroscrelosis of essential hypertension patients

目的探讨糖代谢异常(IGM)对原发性高血压(EH)患者颈动脉粥样硬化(AS)病理改变的影响。方法选取46例单纯EH及36例合并2型糖尿病(T2DM)的EH患者(合并T2DM组),检测其血糖、血脂、血尿酸、纤维蛋白原等代谢参数与血同型半胱氨酸(Hcy)浓度。同时对合并T2DM的EH患者的颈动脉内膜中层厚度(carotid intima-media thiekness,CIMT)进行测定并对CIMT与血清Hcy浓度、血清Hcy浓度与血糖参数之间的相关性进行分析。结果合并T2DM的EH患者体质量指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)、尿酸、纤维蛋白原浓度等代谢参数及血清Hcy浓度均显著高于单纯EH患者(P<0.05或P<0.01)。与单纯EH患者相比,合并T2DM的EH患者颈动脉AS发生率及CIMT均较单纯EH组患者显著增高(P<0.05或P<0.01)。Pearson相关分析显示,在合并T2DM的EH患者中,CIMT与血清Hcy浓度呈正相关(r=0.482,P<0.01),血清Hcy浓度分别与FPG(r=0.645,P<0.01)、HbA1c(r=0.652,P<0.01)呈正相关,但与PBG无相关性(P>0.05)。结论糖代谢异常可与其他心血管疾病(CVD)危险因素协同作用,加重EH患者的血管内皮损伤及启动的AS病变,后者与血糖代谢紊乱程度密切相关,改善糖代谢状态可降低这些EH患者CVD并发症的发生危险。

Objective To explore the effects of impaired glucose metabolism（IGM） on the pathologic process of carotid atherosclerosis（AS） in essential hypertension（EH） patients.Methods Forty-six EH patients（EH group） and 36 EH patients combined with type 2 diabetes mellitus（T2DM） were selected.The levels of metabolic parameters such as body mass index（BMI）,blood glucose,blood lipidogram,serum uric acid（UA） and fibrinogen（Fib）,serum homocysteine（Hcy）,and the carotid atherosclerotic plaques were detected in simple EH group and EH combined T2 DM group.Relationship between Hcy and carotid intima-media thickness（CIMT）,parameters of blood glucose was obsverved and analyzed in EH combined with T2 DM group.Results The levels of BMI,FBG,PBG,HbA1 c,TG,LDL-C,ApoB,serum UA and Fib were significantly higher than those of EH group（P〈0.05 or P〈0.01）.The incidence rate of AS plaques and CIMT levels were significandy higher in EH combined with T2 DM group compared with EH group（P〈0.05 or P〈0.01）.Pearson correlation analysis revealed that CIMT was positively related with the level of serum Hcy（r=0.482,P=0.003）,and the level of serum Hcy was positively correlated with FPG（r=0.645,F0.01）,HbA1c（r=0.652,P〈0.01）,respectively.Conclusions IGM might aggravate vascular dysfunction and accelerate the pathologic process of AS in EH patients by interacting with other cardiovascular disease（CVD） factors synergistically.Therefore,improvement of glucose metabolism could reduce the risk of CVD in those EH patients.